SR 24-07 Dated 03/24

STATE OF NEW HAMPSHIRE

DEPARTMENT OF HEALTH & HUMAN SERVICES - Bureau of family assistance (bfa)

INTER-DEPARTMENT COMMUNICATION

SUMMARY

This Supervisory Release (SR) releases mandatory income limit increases for the following programs:

·              Qualified Medicare Beneficiaries (QMB);

·              Specified Low-Income Medicare Beneficiaries (SLMB and SLMB135);

·              Granite Advantage Health Care Program (GA);

·              12-Month Extended Medical Assistance (EMA);

·              Children’s Medicaid (CM);

·              Pregnant Women Medical Assistance (PW MA);

·              Family Planning Expansion Category (FPEC);

·              Qualified Disabled Working Individuals (QDWI);

·              Expanded Children’s Medicaid (ECM);

·              Medicaid for Employed Adults with Disabilities (MEAD); and

·              Medicaid for Employed Older Adults with Disabilities (MOAD).

This SR also releases updates to the:

·           resource limits for MEAD and MOAD;

·       gross annual income used to determine if a relative is liable to contribute to the support of an individual requesting State Supplement Program (SSP) financial assistance;

·           5% MAGI-specific income deduction;

·        Financial Assistance for Needy Families (FANF) Payment Standard, which is also used for Refugee Cash Assistance; and

·          Federal tax filing requirement thresholds.

These increases are effective March 1, 2024 and are based upon the federal poverty guidelines (FPGs) published in the Federal Register, dated January 11, 2024 (89 FR 2961). 

POLICY

Qualified Medicare Beneficiaries (QMB)

For QMB, monthly net income must be less than or equal to 100% FPG, pursuant to 42 USC 1396d(p)(2)(C).

Specified Low-Income Medicare Beneficiaries (SLMB)

For SLMB, monthly net income must be greater than 100% FPG, but less than or equal to 120% FPG, pursuant to 42 USC 1396a(a)(10)(E)(iii).

SLMB135

For SLMB135, monthly net income must be greater than 120% FPG, but less than or equal to 135% FPG, pursuant to 42 USC 1396a(a)(10)(E)(iv).

Granite Advantage Health Care Program (GA)

For GA, monthly net income must be less than or equal to 133% FPG, pursuant to 42 USC 1396a(a)(10)(A)(i)(VIII) and 42 CFR 435.119(b)(5).

12-Month Extended Medical Assistance (EMA)

For the second 6 months of 12-Month EMA, monthly net income must be less than or equal to 185% FPG, pursuant to 42 USC 1396r-6(b)(3)(A)(iii)(III).

Children’s Medicaid (CM), Pregnant Women Medical Assistance (PW MA), and Family Planning Expansion Category (FPEC)

For CM, PW MA, and FPEC, monthly net income must be less than or equal to 196% FPG as described in the Medicaid state plan and pursuant to 42 CFR 435.118(c)(2)(ii) (for CM), 42 CFR 435.116(c)(2)(i) (for PW), and 42 CFR 435.214(c)(1) (for FPEC).

Qualified Disabled Working Individuals (QDWI)

For QDWI, monthly net income must be less than or equal to 200% FPG, pursuant to 42 USC 1396d(s)(2).

Expanded Children’s Medicaid (ECM)

For ECM, monthly net income must be higher than 196% FPG, but no higher than 318% FPG as described in the Medicaid state plan and pursuant to 42 CFR 435.229(c)(3).

Medicaid for Employed Adults with Disabilities (MEAD)

For MEAD, the individual’s monthly net income, or the individual’s monthly net income combined with the spouse’s monthly net income if living together, must be less than or equal to 450% FPG, pursuant to He-W 841.03(a)(5).

Medicaid for Employed Older Adults with Disabilities (MOAD)

For MOAD, the individual’s monthly net income, or the individual’s monthly net income combined with the spouse’s monthly net income if living together, must be less than 250% FPG, pursuant to 42 USC 1936a(a)(10)(A)(ii)(XIII) and RSA 167:3-m, III. However, there is an additional MOAD income disregard that is available when net income ranges from 250% FPG up to and including 450% FPG. The purpose of the additional MOAD disregard is to align the under 250% FPG net income limit of MOAD with the 450% FPG net income limit of MEAD.

MEAD and MOAD – Resource Limits

To be eligible for MEAD or MOAD, the individual’s countable resources cannot exceed the following, pursuant to He-W 841.03(a)(6) [for MEAD; rules are pending for MOAD].

Annual Income Limits for Legally Liable Relatives for State Supplemental Program (SSP) Financial Assistance

Income limits to determine if a liable relative is able to contribute to the support of an applicant or recipient requesting SSP financial assistance are based upon 200% FPG, pursuant to He-W 622.01(d)(5).

5% MAGI-Specific Income Deduction

This income deduction is only applied if the applicant or recipient meets all categorical eligibility requirements for the Modified Adjusted Gross Income (MAGI) categories of medical assistance except the individual is over income. At that point, determine eligibility by subtracting the 5% MAGI-specific income deduction from the individual’s income based on household size, pursuant to 42 CFR 435.603(d)(4). If still ineligible for the MAGI category of medical assistance, determine In and Out medical assistance.

FANF Payment Standard

The FANF payment standard, used in determining eligibility and grant amount for FANF programs and refugee cash assistance, is equal to 60% FPG, pursuant to RSA 167:77-g.

Federal Tax Filing Requirement Thresholds (for 2023 tax year, filing in 2024)

The federal tax filing requirement thresholds are set by the Internal Revenue Service (IRS).  These thresholds are released annually by the IRS in Publication 501 Dependents, Standard Deduction, and Filing Information and are incorporated in the annual March mass change.

Tax Filing Requirements for Most Taxpayers

Tax Filing Requirements for Children (up to age 19) and Other Single Dependents

NEW HEIGHTS & NH EASY SYSTEMS PROCEDURES

New HEIGHTS will update all reference tables with the new income limits effective March 1, 2024, and will use the new amounts for any eligibility periods beginning on or after that date.

Approximately 3,973 cases will experience a change and will be incorporated into the daily “mass changes” that will run the evenings of February 16 and 19, 2024. 

Note: Currently open PW MA, FPEC, and 12-Month EMA cases are not affected by the new income limits. Similarly, children eligible for CM or ECM are also not affected by the new income limits, although some children eligible for ECM may, with the increase in the income limits, instead be eligible for regular CM. Even if this happens, though, there is no change in the coverage period or benefits the child receives, merely the category of assistance changes. However, rerun SFU and EDBC at the next change action so that the new case budgets reflect the new limits.

Post Mass Change Reports

The two reports described below will be produced as a result of the mass change. These reports will be located in the New HEIGHTS Reports folder under both the D.O. Daily Reports and Mass Change Reports folders.

NMC540RA: AG’s Affected by MC

This report lists all cases upon which the Mass Change ran successfully through confirmation. It contains the following information: D.O., Worker Name, Client Name, and Case Number. This report will be available as noted above.

NMC550RA: MC Exception Report

This report lists cases that were selected for computation during the Mass Change but were not confirmed due to some discrepancy in data. These cases require further District Office action. The report contains the following information: D.O., Worker Name, Client Name, Case Number, Reason for Exception, and Mass Change Type.

The Exception Report will contain:

·    QDWI/QMB/SLMB cases, In and Out medical assistance cases in “deductible” status, because New HEIGHTS cannot confirm a pending case during a mass change; and

·         SLMB cases that:

-       due to increased income, closed and then re-opened for SLMB135; and

-       are also participating in another Medicaid program.

·         Procedures for Cases that have Exceptioned Out Due to Pending Verification

-    upon obtaining verification, rerun EDBC.

·         Procedures for SLMB135 Cases that have Exceptioned Out Due to Concurrent Medicaid Coverage

Individuals who are eligible for Medicaid are not eligible for SLMB135. The case will open Medicaid and the SLMB135 will be denied due to no eligibility.

DESCRIPTION OF REVISIONS MADE TO FORMS

New Hampshire Bureau of Family Assistance Fact Sheet and BFA Program Net* Monthly Income Limits have been updated to incorporate the current figures that are effective March 1, 2024.  New Hampshire Bureau of Family Assistance Fact Sheet is available internally on the N:\ drive and both forms are available on the DHHS website at https://www.dhhs.nh.gov/forms-documents-0.

POLICY MANUAL REVISIONS

Revised Adult Assistance Manual Topics

Section 311.01                       Relative’s Ability to Contribute

Revised Family Assistance Manual Topics

Section 601, Table B              Maximum Payment Standard

Revised Medical Assistance Manual Topics

Section 407.01                        Categorically Needy Medical Assistance

Section 601, Table C              Qualified Medicare Beneficiary (QMB)

Section 601, Table D              Specified Low Income Medicare Beneficiary (SLMB) and SLMB135

Section 601, Table E              Qualified Disabled and Working Individual (QDWI)

Section 601, Table F              Medicaid for Employed Adults with Disabilities (MEAD)

Section 601, Table F-a           Medicaid for Employed Older Adults with Disabilities (MOAD)

Section 601, Table G              PIL, Granite Advantage, EMA, CM, Pregnant Women, FPEC, and Expanded CM                                  

Section 601, Table J               5% MAGI Deduction

Section 601, Table K              Federal Tax Filing Requirement Thresholds

IMPLEMENTATION

Changes identified in this SR are effective March 1, 2024 for current cases and apply to any new cases processed on or after that date.

CLIENT NOTIFICATION

Assistance groups experiencing a change in eligibility due to the mass change will receive the following Notice of Decision (NOD):

Federal income limits for certain medical assistance programs and FANF were updated effective March 1. Your eligibility or benefits, as shown in the old and new budgets below, were refigured using this or other changes that occurred in your case.

Individuals who had a prescription copay prior to the March mass change because their income was greater than 100% of the FPG, but after being run through the mass change will no longer have a copay due to the increased 2024 FPGs, will receive New HEIGHTS-generated AE0128, Copay Letter.

QMB, SLMB, SLMB135, and QDWI

Federal law mandates that the yearly January Social Security Administration/Supplemental Security Income (SSA/SSI) Cost of Living Adjustment (COLA) increase cannot be used to determine QMB, SLMB, SLMB135, and QDWI eligibility until after the annual update to the FPGs. These cases will now have their current income, including the COLA, compared to the new limits for their programs by New HEIGHTS and appropriate notices will be generated to all cases that change category or close.

In and Out Medical Assistance

New HEIGHTS will run In and Out Medical Assistance cases for any of the medical assistance categories that have experienced an income limit increase and are in “deductible” status through the mass change. Deductible status refers to cases that have not yet opened for Medicaid because the spenddown has not been met.

As a result of the increase in the income limits, some individuals currently eligible for In and Out medical assistance may become eligible for medical assistance under the appropriate category of assistance. If eligible for a different medical coverage, New HEIGHTS will send a trigger to MMIS alerting them of the eligibility for the category of medical assistance and will generate the regular “open for medical assistance” NOD to the client.

Currently open In and Out Medical Assistance cases who are receiving Medicaid because they have met the spenddown will not be run through the mass change. For open Medicaid In and Out Medical Assistance cases, New HEIGHTS will rerun SFU and EDBC at the next change action so that the case budgets reflect the new limits.

TRAINING

No special training is planned or needed.

FORMS INSTRUCTIONS

DISPOSITION

This SR may be destroyed or deleted after its contents have been noted and the revised manual topics released by this SR have been posted to the Online Manuals.

DISTRIBUTION

This SR will be distributed according to the electronic distribution list for BFA policy releases. This SR, and revised Online Manuals, will be available for agency staff in the Online Manual Library, and for public access on the Internet at https://www.dhhs.nh.gov/sr_htm/sr.htm, effective March 1, 2024.

BFA/DMS:sh